FODMAPs and bad guts - is gluten unfairly getting the blame?

1 August 2014

by Dr Nigel Larsen

In some people, these carbohydrates are not digested and absorbed into the bloodstream and end up being fermented by bacteria in the large intestine where the result is bloating and general discomfort. The FODMAP acronym comes from the general classification of these problematic carbohydrates – Fermentable Oligosaccharides, Disaccharides, Monosaccharides, and Polyols. Anyone who bloats after a feed of artichokes or onions, knows the unpleasantness of the fermentation effects all too well. The chronic conditions and their correlation with ingestion of these carbohydrates have only recently come to light through ground-breaking research in Australia. And it is the Aussies who are leading the charge in providing dietary advice and off-the-shelf foods to help people with FODMAP symptoms that cannot be linked to other causes.

People self-diagnose and higher awareness of so-called “gluten intolerance” (which supposedly gives similar gut symptoms to what is now known as FODMAPs) means that gluten gets the blame. Gluten is well proven to be the cause of the celiac disease that afflicts about 1 person in 100, but that is another matter – chiefly that clinical symptoms manifest themselves as observable damage to the villi on the walls of the small intestine. Gluten intolerance is also known as non-celiac gluten sensitivity (NCGS) and self-diagnosis usually comes about when an individual stops eating gluten-containing foods and the troubling gut problems go away. However, the Australian research is finding that when most people with so-called gluten-intolerance are fed a diet free of FODMAPs and are then challenged with gluten, the symptoms of “gluten-intolerance” stay away. In a recent clinical trial, this happened to 34 out of 37 “gluten intolerant” subjects. Why a gluten-free diet alleviates symptoms and convinces people into thinking they are gluten intolerant, is because FODMAPs and gluten go hand-in-hand in foods that comprise the gluten-containing grains that “gluten-intolerant” people avoid.

Dietary surveys show that even though cereal grains like wheat and rye contain lower levels of FODMAPs than other foods like onions, artichokes and various fruits, because we generally eat a higher proportion of grain foods we are ingesting more FODMAPs from the latter staple sources. Hence, for anyone who has a genuine FODMAP condition, avoiding grain foods helps alleviate the symptoms.

FODMAPs is a tricky condition to treat and it seems that what works for some people, may not necessarily work for someone else. Therefore, a fair bit of experimentation might be needed for someone to determine what diet suits best. However, the medical fraternity is becoming increasingly more aware of FODMAPs and there are very good websites available to advise on what high-FODMAP foods an individual could start avoiding.

There is an interesting psychology to all this – we’re so aware of the notion of “gluten intolerance’ that participants in the Australian clinical trials who reacted positively to the removal of FODMAPs and suffered no adverse response to gluten, refused to believe that gluten was not the cause of their conditions!

Finally, there is a large school of scientists out there too, who need to catch up with the ground-breaking research that has been done in Australia. Plenty of papers in the literature cite “the facts” about the 1% of consumers with celiac disease (true) and the other 8% or so who suffer from gluten intolerance (maybe not so true). One thing I think is certain, and that is the Australian work will lead to a plethora of further clinical studies that should help to lay these matters to rest one way or another. Or will they? The recent reopening of the saturated fats debates suggests there will be plenty of scope to research and debate these issues in the years to come. In the meantime, maybe we should not be so ready to blame gluten.

 Originally published on the Riddet Foodlink website.

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